IT Healthcare Consultant - Business Analyst - Advanced

IT Healthcare Consultant Business Analyst Advanced Clinical Analyst

80% Remote | Columbia, SC | Medicaid / Healthcare / Medical Coding

About the Job

• Division: Delivery of Automated Systems for Healthcare (DASH)
• Duration: 12-month contract
• Possibility for Extension: Yes
• Interview Process: 1 round, virtual/online
• Work Location: 80% remote. The selected resource will be required to report onsite in Columbia, SC for certain trainings, meetings, and other business needs as directed by management.
• Candidate Location: Candidates may reside anywhere in the United States. However, they must be willing and able to travel onsite to Columbia, SC with notice from management, at the resource s expense.
• Location Preference: Strong preference for candidates currently located in South Carolina, North Carolina, or Georgia.
• Screening Requirements: State mandatory Criminal, Credit and E-Verify background checks
• Number of Openings: 1

Position Overview

DataSoft Technologies is seeking an experienced IT Healthcare Consultant Business Analyst Advanced Clinical Analyst to support the South Carolina Department of Health & Human Services (CLIENT), the State Medicaid Agency for South Carolina.

This is a new position supporting the Reference Administration function and requires a candidate with a strong healthcare background who is also a Certified Medical Coder. The selected consultant will support medical code change requests by researching issues, analyzing requirements, and developing recommendations for policy owners, process owners, stakeholders, and agency leadership.

The role will also support related process-improvement initiatives, Medicaid Management Information System (MMIS) enhancements, and future MMIS replacement activities. The successful candidate will serve as a subject matter expert in medical coding methodologies and will help ensure that coding-related business rules, policies, and processes are accurately understood, documented, and maintained. CLIENT 13856

This position is well suited for an experienced healthcare professional who can combine medical coding expertise, business analysis, clinical knowledge, documentation, and stakeholder engagement in a complex and evolving Medicaid environment.

Department and Project Environment

CLIENT is the State Medicaid Agency for South Carolina. The department is seeking an individual who is comfortable working on complex, change-oriented initiatives with motivated team members and multiple stakeholders.

The position was created to provide additional support for the workload and complexity associated with Reference Administration responsibilities, maintain operational efficiency, meet defined deliverable dates, and support succession planning within the team. CLIENT 13856

The broader initiative is a multi-year effort focused on providing consulting services to operations and policy staff supporting the current Medicaid Management Information System (MMIS). The Clinical Analyst will help build and maintain the knowledge necessary for policy and process owners to make informed recommendations that affect Medicaid members and providers. CLIENT 13856

Scope of the Role

The primary focus of this position is to support the ongoing maintenance and administration of CPT/HCPCS and ICD-10 codes and to serve as a subject matter expert for medical coding, Medicaid policy, and related business processes.

The selected consultant will work across business, policy, clinical, and technical teams to review coding changes, assess business impact, maintain requirements and business rules, and support the accurate application of medical codes within the Reference Administration subsystem.

Key Responsibilities

• Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
• Performs initial review of codes to determine scope of changes.
• Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
• Conducts meetings with Agency personnel, stakeholders, and process owners.
• (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
• Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
• Research business rules, requirements, and models to complete initial analysis and recommendations.
• Maintains business rules, requirements, and models in a repository.
• Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
• May serve as a back-up to other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
• Other project-related duties, as assigned or required

The job description specifically identifies CPT/HCPCS and ICD-10 code maintenance, stakeholder meetings, business-rule analysis, documentation, and SME responsibilities as central to the position.

Required Skills

• Bachelor s degree in healthcare related field.
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
• 3+ years experience in healthcare
• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
• 3+ years of strong knowledge of formal business process documentation

Preferred Skills

• 3+ years experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
• Resource is local to South Carolina, North Carolina, or Georgia

Required Education

Bachelor s degree in healthcare related field.

An equivalent combination of experience and education may be considered with prior CLIENT hiring team review and approval. CLIENT 13856

Required Certification

Candidate must be currently credentialed as one of the following:

• CPC Certified Professional Coder
• CCS Certified Coding Specialist

This is a required qualification for the position. CLIENT 13856

Additional Qualifications

The ideal candidate will demonstrate strong analytical, communication, organizational, and relationship-management skills and should be comfortable managing multiple work efforts simultaneously.

Important capabilities include:

• Strong medical coding experience
• Strong CPT/HCPCS and ICD-10 translation knowledge
• Ability to understand how medical codes relate to claims processing
• Ability to understand business and functional requirements
• Strong time-management skills
• Ability to manage multiple priorities and assignments simultaneously
• Strong collaboration and relationship-building skills
• Ability to work effectively with policy owners, process owners, stakeholders, management, and project teams
• Strong written and oral communication skills
• Strong proficiency in English
• Ability to communicate effectively with executive management, line management, project management, and team members
• Clinical background is beneficial but not required
• Experience in hospital, office, or clinic environments is beneficial

The SOW specifically notes the importance of analytical ability, medical coding, CPT/HCPCS and ICD-10 translation, business and functional requirements, time management, and collaboration skills. CLIENT 13856

Work Location and Travel Requirements

This position is 80% remote.

The selected resource will be required to report onsite in Columbia, South Carolina for certain trainings, meetings, and other project or business needs.

Candidates may reside anywhere in the United States, but they must be willing and able to travel onsite to Columbia, SC when requested by management and with appropriate notice.

Any required travel to Columbia, SC will be at the resource s expense.

There is a strong preference for candidates located in South Carolina, North Carolina, or Georgia, although candidates outside those states may still be considered if they meet the required qualifications and can satisfy the onsite travel requirement.

About our Company

DataSoft Technologies is a highly recognized provider of professional IT Consulting services in the US. Founded in 1994, DataSoft Technologies, Inc. provides staff augmentation services for Information Technology and Automotive Services. Our team member benefits include:

• Paid Holidays/Paid Time Off (PTO)
• Medical/Dental Insurance Group
• Accident/Critical Illness Insurance
• Life Insurance
• 401 (K)